INSTRUCTIONS Rising prevalence of renal calculi: Treatments and considerations

TEST INSTRUCTIONS

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Rising prevalence of renal calculi: Treatments and considerations

LEARNING OUTCOME: Participants will demonstrate competency in clinical reasoning regarding renal calculi treatments and considerations by achieving a minimum score of 70% on the outcomes-based posttest.

LEARNING OBJECTIVES: After completing this continuing professional development activity, the participant will be able to apply knowledge gained to a case scenario to: 1. Identify risk factors associated with renal calculi. 2. Recognize safe pharmacotherapies for patients with renal calculi. 3. Recognize etiologic mechanisms that contribute to renal calculi-related pain. 4. Select appropriate diagnostic strategies for patients with renal calculi.

Placing yourself in the role of the ED nurse providing care for DH, refer to the case study provided in the attached article to answer questions 1-4.

1. Which characteristic places DH at higher risk for renal calculi?

a. age

b. sex

c. current medications

2. As you review DH's health history, you recognize that DH is also at a higher risk of developing renal calculi due to his

a. active lifestyle.

b. increased water consumption.

c. high protein, low carbohydrate diet.

3. DH passes a stone in his urine which is sent for analysis. You explain to DH that his renal calculus is the most common type, which is primarily composed of

a. cystine.

b. calcium.

c. uric acid.

4. DH is concerned about the intense pain he experienced. You explain that his pain was likely renal colic, caused by

a. perforation of the bladder wall.

b. small tears in the ureters and bladder.

c. ureteral spasm and kidney swelling.For questions 5-10, refer to the case scenario below:DH returns to the ED 3 months later with severe left flank pain for the previous 48 hours. He describes it as a sharp and stabbing pain of 10/0-10 intensity that radiates to his lower back associated with nausea. He has been drinking more water and recently took acetaminophen for pain with partial, temporary relief. His vital signs are temperature,100.8 F; heart rate, 98; respiratory rate, 22; blood pressure, 128/72.

5. You teach DH what to expect during his ED visit and explain that, in the absence of contraindications, the standard radiologic test for diagnosing renal calculi is a(n)

a. non-contrast CT scan.

b. US of the kidneys and bladder.

c. KUB.

6. DH is requesting pain medication. You anticipate administering the most effective class of medication in the management of pain related to renal calculi, which is

a. opioids.

b. antispasmodics.

c. NSAIDs.

7. Prior to starting an I.V. bolus of 1 liter of normal saline as prescribed, you review DH's health history. Which comorbidity, if present, might indicate an increased risk related to the infusion?

a. diabetes mellitus

b. heart failure

c. obesity

8. HD's imaging revealed 3.5 mm and 5 mm calculi in the left ureter. You inform him that renal calculi typically pass spontaneously from the urinary system within 40 days if they are equal to or less than

a. 4mm.

b. 5mm.

c. 6mm.

9. Given DH's continued severe pain, you know that he may be a candidate for MET, which includes

a. beta-blockers

b. alpha-blockers

c. angiotensin receptor blockers

10. You educate DH on measures to reduce the risk for future renal calculi, including decreasing sodium intake to less than

a. 2300 mg per day.

b. 3300 mg per day

c. 4300mg per day